OBJECTIVES The UNAIDS 90-90-90 and other cross-sectional metrics can lead to potentially counterintuitive conclusions when used to evaluate health systems' performance. This study demonstrates how time and population dynamics impact UNAIDS 90-90-90 metrics in comparison with a longitudinal analogue. DESIGN A simplified simulation representing a hypothetical population was used to estimate and compare inference from UNAIDS 90-90-90 metrics and a longitudinal metrics based on Kaplan-Meier-estimated 2-year probability of transition between stages. METHODS We simulated a large cohort over 15 years. Everyone started out at risk for HIV, and then transitioned through the HIV care continuum based on fixed daily probabilities of acquiring HIV, learning status, entering care, initiating ART, and becoming virally suppressed, or dying. Within simulations we only varied the probability of ART initiation. We repeated the simulation with an increased probability of death. RESULTS The cross-sectional probability of being on ART among persons who were diagnosed responded relatively slowly to changes in the rate of ART initiation. Increases in ART initiation rates caused apparent declines in the cross-sectional probability of being virally suppressed among persons who had initiated ART, despite no changes in the rate of viral suppression. In some cases, higher mortality resulted in the cross-sectional metrics implying improved healthcare system performance. The longitudinal continuum was robust to these issues. CONCLUSION The UNAIDS 90-90-90 care continuum may lead to incorrect inference when used to evaluate health systems performance. We recommend that evaluation of HIV care delivery include longitudinal care continuum metrics wherever possible.BACKGROUND CD4 T-cells that express the chemokine receptor, CCR5, are the most important target of HIV-1 infection, but their functions, phenotypes and anatomical locations are poorly understood. We aimed to use multiparameter flow cytometry to better define the full breadth of these cells. METHODS High-parameter fluorescence flow and mass cytometry were optimized to analyse subsets of CCR5+ memory CD4 T-cells, including CD25CD127 Tregs, CXCR3+CCR6- Th1, CCR6+CD161+CXCR3- Th17, integrins α4+ß7+ gut-homing, CCR4+ skin-homing, CD62L+ lymph node-homing, CD38+HLA-DR+ activated cells, and CD27-CD28- cytotoxic T lymphocytes (CTL), in a total of 22 samples of peripheral blood, ultrasound-guided fine needle biopsies of lymph nodes and excised tonsils. CCR5+ antigen-specific CD4 T-cells were studied using the OX40 flow-based assay. RESULTS 10-20% of CCR5+ memory CD4 T-cells were Tregs, 10-30% were gut-homing, 10-30% were skin-homing, 20-40% were lymph node-homing, 20-50% were Th1 and 20-40% were Th17 cells. Up to 30% were CTL in CMV-seropositive donors, including cells that were either CCR5Granzyme K+ or CCR5Granzyme B+. When all possible phenotypes were exhaustively analysed,?&gt;?150 different functional and trafficking subsets of CCR5+ CD4 T-cells were seen. Also, a small population of resident CD69+Granzyme K+CCR5+ CD4 T-cells was found in lymphoid tissues. CMV- and M tuberculosis-specific CD4 T-cells were predominantly CCR5+. CONCLUSIONS These results reveal for the first time the prodigious heterogeneity of function and trafficking of CCR5+ CD4 T-cells in blood and in lymphoid tissue, with significant implications for rational approaches to prophylaxis for HIV-1 infection and for purging of the HIV-1 reservoir in those subjects already infected.OBJECTIVE To evaluate HIV testing yield under several candidate strategies for outreach testing at venues (i.e., places where people socialize and meet new sex partners) in East Africa cross-border areas. DESIGN Population-based cross-sectional biobehavioral survey of people who had not been previously diagnosed with HIV found in venues. https://www.selleckchem.com/products/azd7648.html METHODS We identified participants who would have been tested for HIV under each of 10 hypothetical outreach testing strategies and calculated the proportion who would have newly tested positive for HIV under each strategy. Based on this proportion, we calculated the "number needed to test" (NNT) to identify 1 new case of HIV under each strategy. All estimates were obtained by applying survey sampling weights to account for the complex sampling design. RESULTS If testing were performed at a random sample of venues, 35 people would need to be tested to identify 1 new case of HIV, but higher yield could be found by limiting testing to venues with specific characteristics. Strategies focusing on women had higher testing yield. Testing women employed by venues would result in highest yield of all strategies examined (NNT?=?15), while testing men under age 24 would result in the lowest yield (NNT?=?99). CONCLUSIONS Quantitatively evaluating HIV testing strategies prior to implementation using survey data presents a new opportunity to refine and prioritize outreach testing strategies for the people and places most likely to result in high HIV testing yield.OBJECTIVES Previous studies have suggested that vasodilator therapy may be beneficial for patients with nonocclusive mesenteric ischemia. However, robust evidence supporting this contention is lacking. We examined the hypothesis that vasodilator therapy may be effective in patients diagnosed with nonocclusive mesenteric ischemia. DESIGN Retrospective cohort study. SETTING The Japanese Diagnosis Procedure Combination inpatient database. PATIENTS A total of 1,837 patients with nonocclusive mesenteric ischemia from July 2010 to March 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We compared patients who received vasodilator therapy (vasodilator group; n = 161) and those who did not (control group; n = 1,676) using one-to-four propensity score matching. Vasodilator therapy was defined as papaverine and/or prostaglandin E1 administered via venous and/or arterial routes within 2 days of admission. Only patients who did not receive abdominal surgery within 2 days of admission were analyzed. The main outcomes were in-hospital mortality and abdominal surgery performed greater than or equal to 3 days after admission. After propensity score matching, in-hospital mortality was significantly lower in the vasodilator group (risk difference, -11.6%; p = 0.005). The proportion of patients who received abdominal surgery at greater than or equal to 3 days after admission was also significantly lower in the vasodilator group (risk difference, -10.2%; p = 0.002). CONCLUSIONS Vasodilator therapy with papaverine and/or prostaglandin E1 is associated with lower in-hospital mortality and prevalence of abdominal surgery in patients with nonocclusive mesenteric ischemia.